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The Last Call of the Day

Mark Knudson ~

Why is it always the last call of the day,
Bag packed by the door, and sometimes I’ve even put my coat on,
And then I know that I have to make the call.

If I was smart, I’d schedule a visit, have the nurse set up a time
To have the patient drop by after the test is done,
If only I was smart!

But today it is too late for that, Friday night,
And a weekend of intolerable waiting for the patient,
So I make the call at half past 6.

The first ring means too late to hang up, the second ring raises hope that no one is home,
If I make it to the third ring, I start to rehearse a message,
But with the fourth ring, a soft voice breaks the silence.

The answer is always cancer, it’s never the plague, or leprosy, or even a kidney stone,
Once in a while it’s HIV, and one time it was TB,
But cancer is the real answer.

So I share the news, and I wait for the click
Of a dry tongue trying to form a response,
And I say, “I’m sorry, and I will see you Monday,”
And pick up my bag to head home,
Because it is always the last call of the day.

About the poet:

Mark Knudson is on the faculty of the family-medicine residency program at Wake Forest School of Medicine in North Carolina. He divides his time between caring for patients (some of whom have been his patients for thirty years) and teaching residents. In the course of a long career of writing poetry (humorous poems to celebrate staff, residents and faculty, as well as serious poems that reflect his patient care), this is the first piece of poetry that he’s had published.

About the poem:

“The blessing and curse of caring for patients over many years is that you develop relationships with people that are complex and important. As a result, life-and-death situations take on greater meaning, bringing you a deeper level of sadness for the problems that patients face and a greater appreciation for the ability to be a part of their lives. This poem followed the delivery of a cancer diagnosis to a patient I had known for years–someone who had already dealt with more than enough social, medical, family and financial crises.”

Poetry editors:

Johanna Shapiro and Judy Schaefer

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6 thoughts on “The Last Call of the Day”

  1. Kristen R Nace

    Excellent piece. It brought back the memory of a phone call I received once from a gyn on a Monday. I had just thought to myself ” My test result must have come back normal because surely he would have called last week” when the phone rang. I told him this after he told me he was referring me to an oncologist. ” Well, I would have called Friday, but I didn’t want to ruin your weekend”

  2. Deeply affecting poem. But it reminds me of why I never give anyone bad news late on a Friday. Even if I have to lie and say the test result is not in yet, I see no advantage in making someone have to carry the bad news for two additional days, impotent to respond, sitting there with no way to begin an action plan. So unless there is something we have to do over the weekend to address this news, I’ve always waited until Monday morning.

  3. This walloped me in my gut.I had no expectation of a cancer diagnosis when the doctor called with the news, was a young mother with two little kids. He never asked if anyone else was home before he saud the cancer word.I dropped the black rotary phone and screamed and screamed.There should be a more sensitive way to manage these life threatening diagnoses.

  4. Sara Ann Conkling

    I can say from the perspective of a patient who has received more than one of those calls at 6:30 p.m., that they leave no doubt that the physician cares enough to make the call. The last 6:30 p.m. call for me was my new urologist calling to make sure I was following up with all the required testing for a tumor found on my adrenal gland during routine imaging for kidney stone surgery. My plasma normetanephrine is high, so the kidney stone is now back burner to the adrenal tumor, and the new urologist who cared enough to follow it up has risen in my esteem. I asked a local radiologist to look at historical scans and learned from him that the tumor, while only reported about half the time, has been with me for over 10 years. The radiologists who did report it reported it as inconsequential. This is during a time that I have been in and out of the hospital for years with life-threatening cardiac episodes. So even when the call is bad news, it’s a good call. My tumor is on the way out.

  5. Dr. Knudson:
    Thank you for sharing the “blessing and curse of caring for patients over many years.” As a family doctor myself I have had this “deeper level” for 30 years with several of our Arizona leprosy patients…interesting you should mention them. Because leprosy patients do not die of the disease, yours is the more poignant relationship. And it’s Friday night at 6 pm as I write to you. Peace, brother.

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